Tirzepatide-induced weight loss and obstructive sleep apnea improvement in an adult with type 2 diabetes: A case report.

RATIONALE: Managing type 2 diabetes mellitus (T2DM) in adults with severe obesity frequently coexists with obstructive sleep apnea (OSA), complicating metabolic control and quality of life. Real-world, objective monitoring-documented trajectories through which pharmacologic weight loss enables withdrawal of continuous positive airway pressure (CPAP) remain clinically informative. PATIENT CONCERNS: A 48-year-old man (height 178 cm; weight 129 kg; BMI 40.7 kg/m²) had T2DM and severe OSA diagnosed by polysomnography (PSG), with persistent daytime sleepiness despite CPAP and body-weight fluctuations between 108 and 129 kg. DIAGNOSES: T2DM with class III obesity and severe OSA with prior peak HbA1c of 8.2%. INTERVENTIONS: Beginning in June 2023, tirzepatide was initiated with gradual dose escalation alongside nutritional counseling and light-to-moderate physical activity. At initiation, it was prescribed for glycemic control and weight reduction in T2DM and thus predated the subsequent U.S. FDA approval for OSA. OSA outcomes were later assessed with objective monitoring via CPAP telemonitoring as part of routine comorbidity care. CPAP was continued initially and reassessed after weight loss. OUTCOMES: Within 3 months, weight decreased to 108 kg (BMI 34.1 kg/m²) with improved glycemic control. On CPAP telemonitoring, the device-derived residual apnea-hypopnea index decreased and remained low over time. Given sustained weight loss and improved symptoms, CPAP was discontinued under supervision. At the most recent follow-up, the patient weighed 82 kg (BMI 25.9 kg/m²) and reported improved daytime functioning. No severe adverse events occurred. LESSONS: In selected adults with T2DM and OSA, tirzepatide-associated weight loss may contribute to device-monitored control of OSA on CPAP, enabling supervised withdrawal in carefully selected cases. While single-patient observations cannot establish causality, they complement emerging evidence and can guide patient counseling and hypothesis generation for prospective studies.